Published online Jun 27, 2015. doi: 10.4240/wjgs.v7.i6.86
Peer-review started: January 15, 2015
First decision: March 20, 2015
Revised: April 13, 2015
Accepted: April 28, 2015
Article in press: April 30, 2015
Published online: June 27, 2015
Liver transplantation has been associated with massive blood loss and considerable transfusion requirements. Bleeding in orthotopic liver transplantation is multifactorial. Technical difficulties inherent to this complex surgical procedure and pre operative derangements of the primary and secondary coagulation system are thought to be the principal causes of perioperative hemorrhage. Intraoperative practices such as massive fluid resuscitation and resulting hypothermia and hypocalcemia secondary to citrate toxicity further aggravate the preexisting coagulopathy and worsen the perioperative bleeding. Excessive blood loss and transfusion during orthotopic liver transplant are correlated with diminished graft survival and increased septic episodes and prolonged ICU stay. With improvements in surgical skills, anesthetic technique, graft preservation, use of intraoperative cell savers and overall perioperative management, orthotopic liver transplant is now associated with decreased intra operative blood losses. The purpose of this review is to discuss the risk factors predictive of increased intra operative bleeding in patients undergoing orthotopic liver transplant.
Core tip: Liver transplantation has been associated with massive blood loss and considerable transfusion requirements. The bleeding in orthotopic liver transplantation is multifactorial such as etiology and severity of liver disease, preexisting coagulopathy, previous abdominal surgeries, preoperative hematocrit, surgical techniques and methods of clamping, experience of surgical team, central venous pressure, the use of antifibrinolytics and procoagulants and use of point of care monitoring during the transplantation. The purpose of this review is to discuss the risk factors predictive of increased intra-operative bleeding in patients undergoing orthotopic liver transplant.